DOCUMENT RESUME

ED 091 849 EM 006 206

AUTHOR Robbins, Jerry H.TITLE Health Rights of Children in Mississippi.SPONS AGENCY Governor's Office of Education and Training, Jackson,

PUB DATE Jun 74NOTE 34p.

BDRS PRICE MF-$0.75 HC-$1.85 PLUS POSTAGEDESCRIPTORS Childretn; *Court Cases; Handicapped Students; Health

Education; *Health Needs; Nutrition; *Public HealthLaws; *School Health Services; *State Legislation

IDENTIFIERS *Mississippi

ABSTRACTThe preservation of the public health is .me of the

duties devolving on the Sta-te as a sovereign power. However., thedelivery system for health care,service is not always efficient andeffective, especially in the case of children. This paper, inattempting to define children's rights to health care, examines thestatutory and case law in Mississippi and selected other States onchildren's health rights, and makes recommendations for improvingMississippi laws. (Author/JF)

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HEALTH RIGHTS OF CHILDREN IN MISSISSIPPI

BY

Jerry H. Robbins, Ed.D.

DEPARTMENT OF HEALTH,EOUCATION A WELFARENATIONAL INSTITUTE OF

EDUCATIONwrfis DOC ',MI NT >+AS BEEN REPROD+.rCED T.AACTIY Al RC Cto,IED FROMTHE PE'RSONOROkcANITATIONORIGINAT4N6 t T POLNTSOS V W O R O P L N I O NSSTAITn WI NGT NE CC '0,APILY ItEPRESE NTOrf I(tAL NATIONAL 1N$Ti TUT( OF

OuCATON POStTsON 014 POLICY

This paper is one of a series sponsored by the Governor'sOffice of Education dna Training. Special thanks must go toGovernor William Waller and Dr. Milton Baxter, Executive Directorof the Governor's Office of Education and Training, for providingthe support for the research and writing that have gone intothese papers.

Each of the papers in this series is designed to speakto the following questions: (1) What is the statutory law inMississippi on the subject, if any? (2) What is the statutorylaw in approximately five other states on the same subject?(3) What major cases, if any, have been in courts in Mississippi?(4) In very general terms, what is the status of the case law onthe subject elsewhere? (5) What model legislation, if any, hasbeen proposed by various agencies? (6) What recommendationsseem to follow from the information presented in the answers toquestions 1-5?

The author wishes to acknowledge the assistance indeveloping this paper of Dr. Ronald Partridge, Assistant Pro-feSsor of Educational Administration, The University of Mississ-ippi; Mrs. Kenneth Bender, a nurse; and Yom Collier, a studentin the School of Law at The University of Mississippi.

University, MississippiJune 1974

HEALTH RIGHTS OF CHILDREN IN MISSISSIPPI

by

Jerry H. Robbins, Ed.D.

The preservation of the public health is one of the

duties devolving on the state as a sovereign power. However,

the delivery system for health care service is not always

efficient and effective, especially in the case of children.

Thig paper attempts to define children's rights to health

care.

Statutorl Law

Mississippi. In Mississippi, the schools have certain

responsibilities for the. health of the students, as may be

seen in the following sections of the Mississippi Code

Annotated (1972):

§37 -7 -301. Powers and duties

The boards of trustees of school districts shallhave the following powers, authority, and duties inaddition to all others imposed or granted by law, towit:

(i) To require, upon the recommendation of the StateBoard of Health and the county health officer in whosehealth jurisdiction the school rests, the vaccinationof school children against smallpox, typhoid fever,poliomyelitus or other contagious or infectiousdiseases and to require chest X-rays as soon aspracticable, and to exclude from the schools childrenwho have not been so vaccinated, as soon as practi-cable; however, the provisions hereof shall notapply to children whose parents or guardians arecertified by an officer of their church to be bonafide members of a recognized denomination whosereligious teachings require reliance on prayer or

spiritual means for healing. It is further providedthat no child shall be required to submit to any vac-cination where the parent has caused to be filed withthe board of trustees a certificate of a physician thatsuch vaccination would be dangerous to the health orsafety of such child.

S37-13-19. Instruction in hygiene; physical education.

The state board of education shall make adequateprovision for. . .regular periodic and thorough healthexamination and inspections of pupils and for such rea-sonable correlation as may be necessary for the better-ment of health and treatment of abnormalities throughavailable agencies inside or outside the public schoolsystem. . . .

537-31-33. Utilization of appropriated funds.

For the purpose of enabling the state board ofeducation to comply with the provisions of the federalsocial security act and to continue to extend and improveas far as practicable the services not maintained by saidstate board for locating crippled children and for pro-viding medical, surgical, corrective, and other services,care and treatment, and facilities for diagnosis, hospi-talization, and aftercare for children who are crippledor who are suffering from conditions which lead to crip-

% pling, any and all funds appropriated for physical restor-ation of crippled olbildren for the above purposes may beused for the purposes set forth in this section.

Only recently has Mississippi made provision for testing

for sickle cell anemia. The law establishthg this in the

Mississippi Code Annotated (1972) reads as follows.

541-24-1. Establishment of testing program for sicklecell anemia or sickle cell trait.

The state Board of Health is hereby authorized andempowered to promulgate such rules and regulations nec-essary to establish a program of testing school age chil-dren, before or during the first year of attendance in apublic school, to determine the presence of the diseaseor condition known as sickle cell anemia or sickle celltrait.

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541-24-3. Children to be tested.

In order to accomplish a program of testing forthe condition known as sickle cell anemia and/orsickle cell trait which will be most effective andefficient throughout the state, the State Board ofHealth may, by rule or regulation, require testingof, only those children who, because of race, ethnicgroup or affinity with persons known to be carriersof such condition, are determined to be particularlysusceptible to the condition.

The procedures for handling eye inflammation of young

children are described in the following sections:

541-35-1. "Inflammation of the eyes of new born"defined.

Any inflammation, swelling or redness in eitheror both eyes of any infant, either apart from ortogether with any unnatural discharge from the eyeor eyes of any such infant, independent of the natureo' the infection, if any occurring, any time withintwo weeks after birth of such infant, shall be knownas "inflammation of the eyes of the new born."

§41 -35 -3. Duty to make report as to any inflammationof eyes of new born.

It shall be the duty of any physician, surgeon,obstetrician, midwife, nurse, maternity home or hos-pital of any nature, parent, relative or other personattendant on or assisting in any way whatsoever, anyinfant, or the mother of any infant, at childbirth, orat any time within two weeks after childbirth, knowingthe condition defined in section 41-35-1 to exist,witnin six hours thereafter, to report such fact, asthe state board of health shall direct, to the localhealth officer of the city, town, village, or whateverother political division there may be, within which theinfant or the mother of the infant may reside.

541-35-5. Duties of the local health officer.

It shall be the duty of the local health officer:(1) to investigate or to have investigated each caseof inflammation of the eyes of the new born as filedwith him, in pursuance of the law, and any other suchcase as may come to his attention; (2) to report all

cases of inflammation of the oyes of the nee bornand the result of a'.l such investigations as thestate board of health shall direct; (3) to conformto such other rules and regulations as the statehoard of health shall promulgate for his furtherguidance.

541-35-7. Duties of the state hoard of health.

It shall be the duty of the state board of health:. . .(3) to provide for the gratuitous distributionof a scientific prophylactic for inflammation of theeyes of the new horn, together with proper directionsfor the use and administration thereof, to allphysicians and midwives as may be engaged in thepractice of obstetrics or assisting at childbirth;(4) to provide, if necessary, daily inspection L,.ndprompt and gratuitous treatment to any infant whoseeyes are infected with inflammation of the eyes;the state hoard of health, if necessary, shall defraythe expenses of such treatment from such sums asmay be appropriated for its use; (5) to publish andpromulgate such further advice and informationconcerning the dangers of inflammation of the eyesof the new horn and the necessity for prompt andeffective treatment; . . .

541-35-9. Duty of those in attendance at childbirthto use prophylactic in eyes of new born.

It shall be the duty of the physicians, midwives,or other persons in attendance upon a case of child-birth in a maternity home, hospital, public orcharitable institution, in every infant immediatelyafter birth, to use some prophylactic againstinflammation of the eyes of the neT, horn and to makerecord of the prophylactic used. It shall be theduty of such institution to maintain such records ofcases of inflarrlation of the eyes of the new bornas the state board of health shall direct.

It shall he the duty of a midife in ever' case ofchildbirth under her care, immediately after birth,to use such prophylactic against inflammation ofthe eyes of the neY: horn as the state board of healthrequires.

Sometimes parents or guardians are obstacles to children

obtaining needed medical r.rvices due to their failure to consent

to such services. The following sections of the nississippi Code

Annotated (1972) apply to this situation:

c41-41-3. !Ilia nay consent to surgical or medicaltreatment or procedures

It is here'.)y recognized and established that, inaddition to such other persons as nay be so authorizedand empowered, any one of the follviing persons isauthorized anti empowered to consent, either otally,or otherwise, to any surgical or medical treatmentor procedures not prohibited by law which may besuggested, recommended, prescribed or directed by aduly licensed physician:

(b) Any parent, whether an adult or a minor, for hisminor child. . .

(c) Any married person, whether an adult or a minor,for himself, and where his joinder in the consentof his spouse nay be desired or required, withhis spouse.

(d) Any married person, whether an adult or a minor,for his spouse of unsound mind.

(g) Any emancipated minor, for himself.

(h) Any uaemancipated minor of sufficient intelligenceto understand and appreciate the consequences ofthe proposed surgical or medical treatment orprocedures, for himself.

(i) Any female, regardless of age or marital status,for herself when given in connection withpregnancy or childbirth.

541-41-9. Court or judge nay consent to, or order,medical treatment; procedure, expense of treatment.

. . .[Alny court having a clerk or any judge thereofmay, in either tern time or vacation, upon presentationof the written advice or certificate of one or moreduly lice%Aed physicians that in his or theirprofessional opinion there is an immediate or imminentnecessity l' or medical or surgical treatment or procedurefor a minor. . .,(shall) summarily consent to or order anddirect such :urgical or medical treatment or proceduresfor the minor. . ., providing (1) some person authorizedand empowered to consent to the surgical or medical'treatment or procedures for such minor. . .has refusedor declined to do so and there is no other personknown to he immediately available who is so authorized,

empowered, willing, and capacitated to so consent, and(2) there has been filed with or there is presentedto such court or judge an application for a writ ofhabeas corpus as to such person. . .or some. . .

instrument or pleading. . .invoking the aid orjurisdiction of said court or judge or the state,as parens patriae or otherwise, concerning thewelfare of such person. Any subsequent dismissal,nonsuit, removal, transfer, overruling or denialof such original application, instrument orpleading, or denial of jurisdiction of the courtor judge over the subject matter or necessary parties,shall not retroactively revoke, rescind or invalidateany prior consent.

541-41-13. Physician treating minor for venerealdisease need not obtain parental consent.

Any physician, duly licensed to practice medicinein the State of. Mississippi, who, in the exercise ofdue care, renders medical care to a minor for treat-ment of a venereal disease is under no obligation toobtain the consent of a parent or guardian, asapplicable, or to inform such parent or guardianof such treatment.

Certain children are eligible for services under

"Medicaid," as established in the following section of the

Mississippi Code Annotated (1972):

543-13-115. Persons entitled to receive medicalassistance.

Recipients of medical assistance shall be thefollowing persons only:

(2) Whoare children under twenty-one (21) yearswho except for age or school attendance requirements,would he dependent children under the State's approvedplan under Title IV of the Federal Social Security Act;or

(3) Children in foster hones or private institutionsfor whom Nississippi public agencies are assumingfinancial responsibility-

The youth courts have a responsibility to provide

certain physical or mental health services if a child is

found to he in need of then, as nay be seen in the following

passage from the Mississippi Code Annotated (1)72):

r,43-13-21. nedical o::pnination; transcript of' records;conveyance of child to institution;

The court nay cause any child coning within itsjurisdiction to have a physical and mental examina-tion made. . . . If said medical examination dis-closes that any child is tubercular, feeble-mindedor insane, such child shall not he committed to anystate institution for delinquent or neglected children,but shall be committed in the manner provided by lawto the particular state institution for suchdisabilities or informities.

Illegitimate children are entitled to the same support

from the father for medical and related expenses as legitimate

children. This may he seen in the following section of the

Mississippi Code Annotated (1972):

§93 -9 -7. Obligations of the father--definition.

The father of a child which is or may he bornout of lawful matrimony is liable to the same extentas the father of a child born of lawful matrimony,whether or not, the child is born alive, for thereasonable expense of the mother's pregnancy andconfinement, and for the education, necessary supportand maintenance, and medical and funeral expenses ofthe chjd. A child born out of lawful matrimonyalso includes a child born to a married woman by aman other than her lawful husband.

Alabama. The Code of Alabama (Cum. Supp. 1971) contains

the following provisions affecting the health of children:

g5a (1). Testing of infants for phenylketonuria;objection of parents; rules and regulations.--(a)It shall be the duty of the administrative officeror other person in charge of each institution caringfor infants twenty-eight days or less of age, or thephysician attending a newborn child, or the personattending a newborn child that was not attended bya physician, to cause to have administered to every

such infant or child in his care a reliable test forphonylketonuria (PM), such as the Guthrie test orany other tent considered equally reliable by thestate board of health. Testing and the recording ofthe results of such tests shall be performed at suchtimes and in such manner as may be prescribed by thestate board of health. Provided, that no such testshall be given to any child whose parents objectthereto on the grounds that such tests conflict withtheir religious tenets and practices.

(b) The state board of health shall promulgate suchrules and regulations as it considers necessary toprovide for the care and treatment of those newborninfants whose tests are determined positive, includingbut not limited to advising dietary treatment for such,infants. The state board of health shall promulgateany other rules and regulations necessary to effectuatethe provisions of this section.

S104(15). Individual consent of certain minors.--Anyminor who is fourteen years of age or older, or hasgraduated from high school, or is married, or havingbeen married is divorced, or is pregnant, may giveeffective consent to any legally authorized medical,dental, health or mental health services for himselfor herself and the consent of no other person shall henecessary.

S104(16). Children with minor parents and minor parents.--Any minor who is married, or having been married isdivorced, or has borne a child nay give effective con-sent for any legally authorized medical, dental,health or mental health services for himself, hischild, or for herself or her child.

S104(17). Pregnancy, venereal disease, drug dependency,alcohol toxicity and reportable diseases.--Any minornay give effective consent for any legally authorizedmedical, health or mental health services to determinethe presence of or to treat pregnancy, venereal disease,drug dependency, alcohol toxicity or any reportabledisease and the consent of no other person shall bedeemed necessary.

5104(18). nlen consent not required; minors generally.--Any legally authorized medical, dental, health ormental health services may be rendered to minors ofany age without the consent of a parent or legalguardian when, in the physician's judgement, an attemptto secure consent would result in delay of treatmentwhich would increase the risk to the minor's life,health or mental health.

fa04(19). same; from spolse.--"hen a per' on (minoror adult) has not lived with his or har husband orwife for a period of one year or longer and when thelocation of said person's husband or wife is notknown by the person whose husband or wife is missing,then such person (minor or adult) may give his or herconsent to any legally authorized medical, dental,health or mental health services and the consent ofthe missing husband or wife shall not be required.

F3104(21). Effect of consent of certain minor;liability for rendering services under this chapter;interpretation of chapter.--(l) The consent of aminor who professes to be but is not a minor whoseconsent alone is effective to medical, dental,health or mental health services shall he deemedeffective without the consent of the minor'sparent or legal guardian, if the physician or otherperson relied in good faith upon the presentationsof the minor.

553. General provisions.--The department of educationand the state board of health shall in conjunctionarrange for the examination of each and every childattending the public schools of this state, bothmale and female, for any physical defects of any kind,embracing mental deficiency, diseases of the ear,eye, nose and throat, mouth and teeth, and deformityor dislocation of the hip joints or spinal disease,phymosis(sic), hookworm disease, and any and' all othercommunicable or contagious diseases where eitherthe county board of education or a city board ofeducation or the state department of education hascause to believe that such child has a communicableor contagious disease, and any disease requiringmedical or surgical aid in developing the child intoa strong and hcalthly individual. The several countyboards of education and county boards of health shallco-operate fully with the state hoard of educationand the state board of health in the promotion ofthis work. . . .

The county or city board of education, upon receiptof a report from a medical officer, may suspend saidchild from attendance of any public school if saidmedi::al examiner is of the opinion that saidcommunicable or contagious disease or any otherdisease will endanger the health of the pupilsattending said school.

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Said child may be suspended for so long as saidcontagious or communicable disease or diseasesenumerated above exists, or endangers the pupilsattending said school, within the discretion of theexamining authorities in boards before mentioned.

The Code of Alabama continues:

5554. hen examination made.--Each and every childshall be examined before October first in each andevery year by the county health officer, and thestate superintendent of education shall have Llanksprinted to he furnished by' the county superintendentof education to the various school districts. Thecounty health officer of each county shall make suchphysical examinations of the school children and heshall secure such assistance from the county boardof health as is necessary. All examinations heldunder this chapter shall be without charge to thechild or its parents.

5559. County board of health to cooperate.--To theend that the objects and purposes of this chaptermay he fully carried into effect, and the healthof the school children of Alabama may be materiallyimproved, the cooperation of, the county hoard ofhealth in various counties of Alabama, in conjunctionwith the county health officers, is expected withoutchrage to the pent of the child.

California. The laws of the state of California contain

the following provisions in the Yealth and Safety Code :hat

'relate to the health problems of children.

5249. Services for physically defective or handicappedminors; powers and duties of department

The Department of !ealth shall establish andadminister a program of services for physicallydefective or handicapped persons under the age of21 years, in cooperation with the federal governmentthrough its appropriate agency or instrumentality,for the purpose of developing, extending andimproving such services. . . .

5250. Intent

It is the intent of the Legislature through theprovisions of this article to provide, to the extentpracticable, for the necessary medical servicesrequired by physically handicapped children whoseparents are unable to pay for these services, wholly

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or in part. The provisions of this article shallalso include the necessary services rendered by theprogran to physically handicapped children treatedin public schools that provide services for physicallyhandicapped children.

5n5o.5 Handicapped child

"Handicapped child," as used in this articlemeans a physically defective or handicapped personunder the age of 21 years who is in need of services.The director shall establish those conditions comingwithin a definition of "handicapped child" except as.the Legislature may otherwise include in thedefinition. Phenylketonurial hyaline membranedisease, cystic fibrosis, and hemophilia shall heamong such conditions. . .

3250.6 Keeping program abreast of advances in medicalscience; pilot studies

The department shall keep the program abreast ofadvanced in medical science, leading to the inclusionof other handiediving conditions and services withinthe limits of and consistent with the most benefieitAuse of funds appropriated for this purpose. Tlith theapproval of the agency administrator the departmentmay carry out pilot studies to determine the needfor, or the feasibility of, including other handi-capping conditions and services in the program withinthe limits of available funds appropriated for theprogram.

3250.7 Crippled children's services program;priorities

The department shall, without impairing existingprograms, give priority to. . .

1. endocrine and metabolic disorders includingthose posing medical management problems or problemsof identification and diagnosis.

2. Convulsive disorders which are complicatedin medical management or pose difficulties in diagnosis,or both.

3. Blood dyscrasias, including such conditionsas sickle-cell anemia, aplastic anemia, hypoplanticanemia(sic), and comparable disorders of the bloodsystem.

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4. All neoplasms.

5. Severe skin disorders such as epidermolysisbullosa.

5253. Case findings; consent of parent or. gmareian

The department or designated county agency shallcooperate with, or arrange through, local public orprivate agencies and providers of medical care toseek out handicapped children, bringing them expertdiagnosis near their homes. Case findings shallinclude, but not be limited to, children withimpaired sense of hearing. This section does notgive the department or designated agency powerto require r.edical or other form of physicalexamination without consent of parent or guardian.

5253.5 Diagnosis for handicapped children

Tn aecordancewith applicable regulations of theUnited State Children's Bureau, the department anddesignated county agencies shall provide a diagnosisfor handicapped children. Tathin the limits ofavailable funds, the department and designatedlocal agencies may accept for diagnosis a handicappedchild believed to have a severe chronic diseaseor severe physical handicap, as determined by thedirector, irrespective of whether the child actuallyhas an eligible medical condition. . .

5254. Application for services

Whenever the parents or estate of a handicappedchild is wholly or partly unable to furnish for thechild necessary services, the parents or guardianmay apply to the agency of the county which has beendesignated by the board of supervisors of the countyof residence. . .to administer the provisions forhandicapped children. . .

5263. Consent of parent or guardian; exception

This article does not authorize any treatmentservice without the written consent of a narent orguardian except as a person under 18 years is anemancipated minor.

5264. Effect of mental retardation

A handicapped child shall not he denied servicespursuant to this article because he is mentally retarded.

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S280. Detection of preventable heritable disorders;tests and regulations; reports; objections

It is the policy of the State of California tomake every effort to detect, as early as possible,phenylketonuria and other preventable heritable dis-orders leading to mental retardation or physical defects.

The State Department of Health shall have theresponsibility of designating tests and regulationsto be used in executing this policy. Such tests shallbe in accordance with accepted medical practices andshall be administered to each child born in Californiaat such time as the department has established appro-priate regulations and testing methods.

The department shall inform all hospitals or phy-sicians, or both, of required regulations and testsand may alter or withdraw any such requirements wheneversound medical practice so indicates.

The provisions of this section shall not apply ifa parent or guardian of the newborn child objects to atest on the ground that the test conflicts lAth hisreligious beliefs or practices.

§295.1 Testing by local agencies; cost; resultsconfidential

Local public health agencies shall make pregnancytesting services available free or at cost to the personusing such services. The results of any pregnancy testshall be confidential.

§300. Maintenance of program

The State Department of Health shall maintain aprogram of child health.

S302. Compulsory medical or physical examination ofchildren

This article does not give the department powerto force compulsory medical or physical examinationof children.

§304. Report of infant having rhesus isoimmunizationhemolytic disease

Every licensed physician and surgeon or other personattending a newborn infant diagnosed as having

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had rhosus (Pr) isoimmuni%ation hemolytic diseaseshall report such condition to thu ''tats; 1)opartmentof T'utilth on report Eon proscril,cyl by the do partlInn

no. (There are two sections 1,tth the sarisSee below) Leuislative findings

The Legislature finds that medical, educationaland psychological evidence increasingly points toadequate nutrition as a determinant not only of goodphysical health but also of full intellectual develop-ment and educational achievement, with adequate nutritionin the earliest months and years being particularlyimportant for full development of the child's mind andbody, that problens of child nutrition cut acrossincome lines and can result not only from low incomebut also from parental ignorance or neglect and thatthere is a need for a statewide child nutritionprogram which has the potential of reaching allpregnant women and mothers of infants.

gm. (There are two sections with the same number.See below) Estanishment of pilot program

The State Department of Public Health nay establisha five-year pilot project in not more than six countiesto serve areas designated by the city or county healthdepartment or city and county health department asareas of high nutritional need under guidelinesestablished by the department. . . .

5312. "Recipient" defined

As used in this article "recipient" means womenduring pregnancy and infants up to the age of oneyear living in areas designated as an area of highnutritional need.

5315. Distribution of coupons

Coupons in an amount sufficient to meet the nutri-tional needs of a recipient for one month shall begranted to a recipient by facilities and personsreferred to in Section 313 upon the written finding ofnutritional need by the recipient physician or otherlicentiate of the healing arts.

5316. Use of coupons

nutrition coupons shall be used to buy only thoseitems for which the coupons are issued at any marketwhich accepts them.

5310. (There are two sections with the same numher.See above.) ;,tats policy; detection; conductof testa; time

It is the policy of the State of California to makeevery effort to detect, as early as possible, sicklecell anemia, a heritable disorder which leads tophysical defects.

The State Department of Public Health shall havethe responsibility of designating tests and regulationsto be used in executing this policy. Such tests shallbe in accordance with accepted Medical practices.

Testing for sickle cell anemia may be conducted atthe following tines:

(a) Upon first enrollment of a child at an elemen-tary school in this state, such child may be tnsted.

(b) For any child not tested pursuant to sub-division (a), upon first enrollment at a junior highschool or senior high school in this state, as thecase nay be, such child may be tested.

(c) Upon application of any person for a licenseto marry, the parties seeking to be married may betested.

The provisions of this section shall not apply ifa parent or guardian of a minor child sought to hetested or any adult sought to he tested objects tothe test on the ground that the test conflicts withhis religious beliefs or practices.

5311. (There are two sections with the same number.See above.) Testing of population segment.

The State Departnent of Public Health may requirethat a test be given for sickle cell anemia pursuantto Section 310 to any identifiable segment of thepopulation which the department determines is susceptiableto sickle cell anemia at a disproportionately higherratio than is the balance of the population.

-053. Compulsory dental examination or service

Nothing in this article authorizes the state de-partinent to compel dental examinations or services.

Massachusetts. The laws of Massachusetts include the

following provisions affecting the health of children.

f7l-93. Selool Physicians and nurses

lr

The school committee shall appoint one or moreschool physicians and nurses, shall assign them to thepublic schools Yithin its jurisdiction, shall providethem with all proper facilities for the performance oftheir duties and shall assign one or more physiciansto the examination of children who apply for healthcertificates. . ., but in cities where the medicalinspection hereinafter prescribed is substantiallyprovided by the board of health, said ,:oard shallappoint and assign the school physicians and nurses.

571-53A. rnployment of medical personnel by superinten-dency district or union; compensation; removal

A superintendency district. . .or a superintendencyunion. . .may employ one or more school physicians andmay employ one or more school nurses; determine therelative amount of service to be rendered in each town;fix the compensation of each person so employed;apportion the payment thereof among the several towns;and certify the respective shares to the several towntreasurers, A school phySician or nurse so employednay be removed by a two thirds vote of the full member-ship of the joint committee. . .

571-54. Physical examination of school personnel

Every school physician shall make a prompt examina-tion of all children referred to him as provided inthis chapter, and such further examination of teachers,janitors and school buildings as in his opinion theprotection of the health of the pupils may require.rvory such physician who is assigned to perform theduty of examining children who apply for health certifi-cates shall make a prompt examination of every childwho wishes to obtain an employment permit. . .andwho presents to said physician the pledge or promiseof the employer. . .and the physician shall certifyin writing whether or not in his opinion such childis in sufficiently sound health and physically ableto perform the work described in said pledge or promise.

571-5421. School physician; assignment to interscholasticfootball games

A physician employed by a school committee shallbe assigned to every interscholastic football gameplayed by any teams representing a public secondaryschool in the commonwealth.

1-55. Contagious diseases; regulations

A child infected, or in a household where a personis infected with a disease dangerous to the public

health. . .or in a household exposed to contagion fromany such disease in another household, shall not attendany public school while he is no infected or remainsin a household where such infection or exposure existsif the .regulations of the board of health requiresuch exclusion. A child returning to school afterhaving been absent on account of such infection orexposure shall present a certificate from the boardof health or its duly appointed agent that the dangerof conveying such disease by such child has passed;provided, that if such a child returns to school with-out such a certificate, after having been absent on'count of such infection or exposure he shallimmediately be referred to a school pllysician forexamination, and, if it is found by such physician uponsuch examination that such danger has passed, he mayremain at school.

571-55A. Procedure for handling sick children

A child showing signs of ill health or of beinginfected with a disease dangerous to the publichealth. . .shall be sent hone immediately, or as soonas safe and proper conveyance can be found, or shallbe referred to a school physician, who may direct thatsuch child be sent home. In the case of schoolsremotely situated, such other steps may be taken aswill best effectuate the purpose of this section andensure the safety of such child and of the other pupils.The superintendent of schools shall immediately causethe board of health to be notified of all childrenexcluded under this section by reason of any diseasedangerous to the public health.

§71-55C. Eye protection devices

Each teacher and pupil of any school, public orprivate, shall, while attending school classes inindustrial arts or vocational shops or laboratories. . .

wear an industrial quality eye protection device,approved by the department of public safety. Eachvisitor to any such classroom or laboratory shall alsobe required to wear such protective device.

571-56. Sick children; notification to parents

If any child is found to be suffering from anydisease or defect, or if any child is found to haveany defect or disa'Ality requiring tr,eatment, theschool cormittee shall forthwith notify the parent or

. guardian of such child.

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571-57. Examinations for defects in eyes, ears and feet

The committee, or the board of health in thosemunicipalities where school health services are theresponsibility of the board of health, shall causeevery child in the public schools to be separately andcarefully examined. . .to ascertain defects in sightor hearing, and other physical defects tending toprevent his receiving the full benefit of his schoolwork, or requiring a modification of the same in orderto prevent injury to the child or to secure the besteducational results, and to ascertain defects of thefeet which might unfavorably influence the child'shealth or physical efficency, or both, during child-hood, adolescence and adult years, and shall requirea physical record of each child to be kept. . . . Anychild shall 1.,e exeupt on religious grounds from theseexaminations upon written request of parent or guardianon condition that the laws and regulations relatingto communicable diseases shall not be violated.

5111.62A Establishment of children's health campsin cities and towns

In each city and town which accepts this and thesix following sections, . . .there shall, except asprovided by section sixty-two F, he established, with-out unreasonable delay, one or more children's healthcamps for the care and treatment of children of schoolage in said city or tom who upon examination arefound to be in need of such care and treatment, butno child shall be given care or medical treatment whoseparent or guardian objects thereto.

5111-62F. Formation of union children's health campdistrict by two or more cities or towns; manageJent;commission; membership

Any two or more such cities or towns nay vote toform, for such period of tine not exceeding five yearsas such cities or towns may from tine to tine determine,a union children's health camp district for the purposeof establishing therein one o r more union children'shealth camps. . . .

5111-62J. Purnose of school; children from other states

The Massachusetts hospital school shall be maintainedprimarily for the education and care of crippled anddeformed children of the cornom-ealth. . .

19

New York. The Public Health Law of the state of New

'York makes the following provisions for the health of children:

§2500 -a. Test for phenylketonuria

It shall be the duty of (1) the administrativeofficer or other person in charge of each institutioncarilig for, infants twenty-eight days or less of age and(2) the person required. . .to register the birth ofa child, to cause to have administered to every suchinfant or child in its or his care a test for phenyl-ketonuria in accordance with rules or regulations pre-scribed by the commissioner. Testing and the recordingof the results of such tests shall be performed at suchtime and in such manner as may be prescribed by thecommissioner.

52501. Health and welfare services to all children;duty of local boards

1. The local board of health or similar healthauthority of each local health district shall providechildren who attend schools other than public withall or any of the health and welfare services andfacilities, including but not limited to health, surgi-cal, medical, dental and therapeutic care and treatmentand corrective aids and appliances, authorized by lawand now granted or hereafter made available by suchlocal board of health or similar health authority foror to children in the public schools in so far asthese services and facilities may be requested by theauthorities of the schools other than public.

2. Any services or fac3',1ities provided pursuantto the provisions of this section shall be so providednotwithstanding any provision of any charter or otherprovision of law inconsistent herewith.

52502. Report of certain conditions

Any midwife, nurse or other person having the care ofan infant within the age of two weeks who neglects oromits to report immediately to the health officer or toa legally qualified practitioner of medicine of the city,town or place where such child is being cared for, thefact that one or both eyes of such infant are inflamedor reddened whenever such shall be the case, or whoapplies any remedy therefore without the advice, orexcept by the direction of such officer or physicianis guilty of a misdemeanor.

52570. Children's institutions; regular physicianrequired

1. EverY institution in this state, operated for theexpress pUrPose of receiving or caring for dependent,neglected or destitute children or juvenile delinquents,0%cePt hospitals, shall have attached thereto a regularphysician of its selection duly licensed'under the lawsof the state and in good professional standing, whosename and address shall be kept posted conspicuouslywithin such institution.

§2571. Children's in titutions; eXanination ofchildren on admissio

1. The administrative officer or person in chargeof every institution in this state operated for theexpress purpose of receiving or caring for dependent,neglected or destitute children or juvenile delinquents,except hospitals, upon receiving a chila therein, bycommitment or otherwise, shall, before permittingsuch child to contact with other children, causeinquiry to be made concerning the'presence or recentexposure of such child to a communicable disease.

2. If, on the basis of such inquiry, there is reasonto suspect that such child nay be ill or recentlyexposed to a communicable disease, such child shallnot be permitted to contact other children until soauthorized by the regular physician of the institution.A record of the results of all such inquiries and examina-tions shall be kept on file in the institution.

3. A thorough medical examination shall be per-formed on all children either immediately prior toadnission to the institution or shortly thereafter.

52575. Children's institutions; duty of local healthofficer

1. The county, part-county, city (over fiftythousand population) health commissioner or districtstate health officer within whose jurisdiction anyinstitution for the care of children, referred toin this article, is situated, shall immediatelyinvestigate any complaint against the management ofthe institution as to the existence of any conditiontherein dangerous or detri ntal to life or health.

2. If after such investigation, such healthcommissioner or- health officer is satisfied that a

21

condition exists therein which is dangerous ordetrimental to life or health, he shall cause thesaid condition to be remedied without delay.

52500. Physically handicapped children; policy

It is the policy of the state of New York Loprovide medical service for the treatment andrehabiliation of physically handicapped children.

§2581. Physically handicapped children; definitions

As used in this article; 1. "Physically handicappedchildren" means any persons under twenty-one years ofage who are handicapped by reason of a defect ordisability, whether congenital or acquired by accident,`injury, or disease, or who are sufferinroM'long-term disease, including, but without limiting thegenerality of the foregoing, cystic fibrosis, musculardystrophy, nephrosis, rheumatic fever and rheumaticheart disease, blood dysorasies, cancer, brain injured,and chronic asthma, or from any disease or conditionlikely to result in a handicap in the absence of treat-ment, provided, howeVer, no child shall be deprived ofa service under the_provisions of this chapter solelybecause of the degree of mental retardation.

2. "Medical service" means such diagnostic, thera-peutic, and rehabilitative care by medical and para-medical personnel, including hospital and related care,and drugs, prostheses, appliances, equipment and devicesas necessary.

§2582. Physically handicapped children; duty of thedepartment

1. The department shall on its own initiative provide,within the limits of the appropriations made therefor,such Medical service for physically handicapped childrenas in the judgement of the commissioner is needed.

Pennsylvania. The laws of Pennsylvania, in Public

School Code of 1949, as amended, make the following provisions:

§14 -1402. Health services

(a) Each child of school age, shall be given bymethods estAblished'by the Advisory HealthAl0a0,(1)- a vision test by A school nurse, medical technicianor'teacher, 12). a hearing test by A Scht561 nurse or

22

medical technician, (3) a measurement of height andweight by a school nurse or teacher, -(4) tests fortuberculosis under Medical supervision, and (5) suchother tests as the Advisory Health Board may. deemadvisable to protect the health of the child. Visiontdsts.shall be given at least annually and other testsat intervals established by the Advisory Mealth toard.

(a-1) Every :child of school age shall be providedwith school nurse services: Provided, however, thatthe number of pupils under the care of each schoolnurse shall not exceed one thousand five hundred (1,500).

(h) For each child of school age, a comprehensivehealth record shall he maintained by the school districtor joint school board,_ which shall include the results -

of the tests, measurements and regularly scheduledexaminations and special examinations herein specified.

(c) Medical questionnaires, suitable for diagnosticpurposes, furnished by the Secretary of l!ealth and com-pleted by the child or by the child's parent or guardian,at such times as the secretary of health nay direct,_shall become a part of the child's health record.

(d) All teachers shall report to the school nurseor school physician any unusual behavior, changes inphysical appearance, changes in attendance habits andchanges in scholastic achievement, which may indicateimpairment of a child's health. The hurse or schoolphysician or school dentist nay, upon referral by theteacher or on his own initiative, advise e child'sparent or guardian of the apparent need for a specialmedical or dental examination. If a parent or guardianfails to report the results to the nurse or schoolphysician, the nurse or school physician shall arrangea special medical examination for the child.

(e) The school physicians of each district or jointboard shall make a medical examination and a comprehen-sive appraisal of the health of every child of schoolage, (1) upon original entry into school in the Common-wealth, (2) while in sixth ,grade, (3) vhile in eleventhgrade, and (4) prior to the issuance of a farm or domesticservice permit unless the child has been given a scheduledor special medical examination within the preceding fourmonths. l' rhe health record of the child shall be adeavailable-towbMoAchool-physician at .the time of theiegularly schedule'd'health appraisals.

:514-1403. nehtal examinations

23

(a) All children of school age, in the Commonwealth,(i) upon original entry into the school, (ii) while inthe third grade, and (iii) while in the seventh grade,shall be given a dental examination by a school dentist;provided, however, that this requirement shall not applyto those school districts or joint school boards whichhave instituted a program of dental hygiene services asprovided in subsection (b) of this section.

(b) Any school district or joint school board mayinstitute a program of dental hygiene services gorchildren of school age, which program shall be approvedby the Secretary of Health, and for that purpose mayemploy dental hygenists.

§14 -1404. Place of examination, use of hospitalfacilities.

The school physician and school dentist shall conductmedical, dental and other examinations in rooms set asidefor this special purpose and equipped with adequatefacilities and with such other accessories as may berequired by the Secretary of Health for the thoroughexamination of children. The school physicians shallrequire the removal of sufficient clothing to insurecomplete examination. If facilities in schools areinadequate for conducting medical, dental and otherexaminations, the school districts or joint schoolboards and private schools may, subject to the approvalof the Secretary of Health, make arrangements for theuse of laboratories and facilities of hospitals orclinics for examinations herein provi.ded for.

S14-1405. Assistance; presence of parents

Every school physician shall be assisted by a schoolnurse and every school dentist by a dental hygienist, ifavailable, or trained assistant, who shall be presentduring each examination. Parents or guardians of chil-dren (sio] of school age shall be advised in advance ofthe date of examination and urged to be present. Medicalexaminations shall be made in the presence of the parentor guardian._

S14-1406. Recommendations

Recommendations as to medical, surgical or dentalcare ahall_be sent-to each-parent-or ghardian and to-thO'famify Ohy6icianr-or'farciily-dentist on fOrmS preparedor approved, the-Secretary Of Wiaith-vith'instrudtionstoithO'paret or 040146'te consult the family

24

physician or family dentist and to notify the schoolauthorities of the action taken with reSpect to therecommendations.

School physicians or school nurses shall informteachers of the health conditions of pupils which mayaffect behavior, appearance or scholastic performance.

§14- 1407. Examinations by examiners of own choice

In lieu of the medical or dental examinations pre-scribed by this article, any child of school age mayfurnish a repoft of examination made at his ownexpense by his family physician or family dentist. . . .

S14-1409. Confidentiality, transference and removalof health records

All health records established and maintained pur-suant to this act shall be confidential, and theircontents shall be divulged only when necessary for thehealth of the child or at the request of the parentsor guardian to a physician. . . .

In the case of any child of school age who enrollsin any school, public or ptivate, in any district_andwho previously attended school in another district inPennsylvania, the district or school-wherein the'childis newly enrolled shall request and the district orschool where the child previously attended shall sur-render the health record of the child. School districts,joint school boards or private schools, shall notdestroy a child's health record fOr a period of atleast two years after the child ceases to be enrolled,but may surrender such child's health record or portionthereof to his parent or guardian if the child does notre-enroll in an elementary or secondary school-inPennsylvania.

§14 -1410. Employment of school health personnel

Except as otherwise provided in this article, allschool distridts. .shall employ school physiciansand school dentists but only with the approval ofthe Secretary of Health. . . .and shall employ One ormore school nurses. ...For special examinations. -. .

school diettiotS or joint-school boards mali-engagethe'aeri0ea,bf oiAhairi16-1641sta or other licensedme46111 spe &ialists or of optometriate. Any `schooldistrict .magi employ cleittal'hyOrtilets.

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5l4-1413. Supplemental duties of school physicians

Duties of sctlool physicians shall include thevaccination cf children of indigent parents, officialre-vaccination of children having temporary.vaccinationcertificates, physical e%amination of children incidentto the issuance of employment certificates as requiredby the provisions of the Child Labor Act, approvalof the return of pupils who have been absent due to acontagious disease or suspected contagious disease,and such other duties as may he required by the boardof school directors not inconsistent with the rulesand regulations of the Secretary of Health.

Sl4-1414. Care and treatment of pupils

Any school district or joint school board may providefor the care and treatment of defective eyes, ears, andteeth of all children of school age within the district.

§l4-1415. Public assistance for medical, dental orsurgical care

if the medical record of any child at any timediscloses a condition which requires medical, dentalor surgical treatment and the parent or guardian statesto the school authorities that he is financially unableto have a physician or dentist of his choice render suchcare, he shall be advised that the cost of such caremay be provided if application is made to the appropriatecounty board of public assistance. Upon,application, thecounty board of assistance shall authorize payment fornecessary medical, dental or surgical care. . . .

514-1416. Precautions against spread of tuberculosis

No person having any form of tuberculosis in atransmissable stage shall be a pupil, teacher, janitoror any other employe (sic) in any school except ina special school carried on under the regulationsmade for such schools by the Secretary of Health. .

Sl4-1417. Pupils relieved from compulsory attendance

Any pupil prevented from attending school on accountof the health or sanitation laws of this Commonwealth,or by the sanitary regulations of the local board ofhealth or the board of school directors, is relievedfrom complying with the provisions of the act anended.hereby concerning compulsory attendance during the timehe is prevented Proll attending school.

26

f1.4-1419. objections to exa.sinatioe or treatment onreligious grounds

This article shall not construed to conpol anyperson to submit to any medical or dental examinationor treatment under the authority of thin act yhenthe person or the parent or guardian of the person, ifa minor, objects to the examination or treatment onreligious grounds or to permit any discriminationagainst any person on account of such objections:Provided, That exemption from medical or dentalexamination shall not be granted if the Secretary ofHealth finds that facts exist under which the exemptionconstitutes a present substantial menace to the healthof other persons exposed to contact with the unexaminedperson.

Case Law

Mississippi. One of the few cases that has come

before the Mississippi Supreme Court concerning the health

of children x:.as 7!artmen v .!ay. (1) In this case a child eight

ynars old was excluded from the public schools of Biloxi )ecause

he had not been vaccinated against smallpox. The school

authorities based their action on an ordinance of the city of

Biloxi and on a resolution of the board of trustees of the city

public schools, both requiring all children to be vaccinated

against smallpox before they could enter the schools. The child

through his father claimed that the restrictions were invalid and

constituted no reasonable excuse or basis for the exclusion

of the boy from the public schools.

The court found for the school authorities, noting that

the Legislature had expressly authorized municipal authorities

"to make regulations to secure the general health of the

municipality" and "to make regulations to prevent the,intro-

27

duction end spread of contagious or inectious anel

to "mal:e quirantine laws (-).r that purpoel."

At the "insissippi had a cor'pulsory attendance

law. The court held that the regulation for vaccination took

precedence, noting that, taken together, the requirements, "do

not mean that a child is entitled to attend a plPlic school

regardless of his conduct, hut, on the contrary, that it is

subject to such reasonable rules for the governrent of the

school as the trustees thereof may see fit to adopt." (2)

In a recent case (3), the federal district court held

that relatives with whom a dependent child is living are en-

titled to benefits under section 7290-39 ,lississippi Code

Annotated (1942) , including reimbursement for medical expenses

incurred due to the denial of the benefits to the welfare

mother or other caretaker relatives.4,10

LlsetAlere. Generally, courts have held that measures

prescribed by municipal or school authorities as a condition

of school attendance do not conflict with statutory (Jr

constitutional provisions giving school-age children the

privilege of attending school. (4) Similarly, courts have

held that the prescription of health measures as a condition

of school attendance is not inconsistent with compulsory educa-

tion laws. (5) School districts in some instances have adopted

regulations requiring the presentation of a certificate based

on a physician's examination as a condition of admission to

school. Jurisdictions have allowed such regulations as being

within the police power of the particnlar states which they

28

have delegated to those in charge of the public schools. Con-

sequently, these regulations need not depend upon an express

statement in the statutes. (G)

Although one jurisdiction has held that school boards

have the power to employ doctors, dentists, and nurses, inle-

pendently of any mention in the statutes, (7) another has

clearly limited the rendering of medical, surgical, and dental

services to pupils as being beyond the powers to be exercised

by a school district or its officers, and has said that this

power does not exist in the absence of express legislative

language so providing. (8)

Many jurisdictions have allowed the requirement that

children be vaccinated as a condition to enrolling in school. (9)

,A statute to this effect has been held by the U.S. Supreme Court

to be a valid exorcise of the police power of the state. (10)

It was stated that the right to attend the public schools is

necessarily subject to some restrictions and limitations in the

interest of the public health and therefore, no constitutional

rights are violated. (11)

Recommendations

Based on the information presented above, it is re-

Commended that;

1. There be enacted by the legislature a provision

for the testing of infants for phenylketonuria (MU) similar

to the provisions in Alabama, i.e.,

29

It shall be the duty of the administrative officeror other person in charge of each institution caringfor infants tYenty-eight days or loss of age, or thephysician attending a newborn child, or the personattending a newborn child that was not attended 1:1, aphysician, to cause to have administered to ev.iry schinfant or child in his care a r-liable test for phenyl-hetonuria (PIT) , such as the Out.,hrio test or any othertest considered equally reliable by the state board ofhealth. Testing and the recording of the results ofsuch tests shall be performed at such times and in suchmanner as nay be prescribed by tht state hoard of health.Provided, that no such test shall be given to any, childwhose parents object thereto on the grounds that suchtests conflict with their religious tenets and practices.

The state board of health shall promulgate suchrules and regulations as it considers necessary toprovide for the care and treatment of those newborninfants whose tests are determined positive, includingbut not limited to advising dietary treatment for suchinfants. The state board of health shall promulgateany other rules and regulations necessary to effectuatethe provisions of this section.

As a refinement, consideration should he given to including in

such a law not only a test for Pla), but for "other preventable

heritable disorders leading to mental retardation or physical

defects," with the state board of health having the authority

to designate the tests and to promulgate the necessary re-

gulations to administer the tests.

2. There be conducted a feasibility study of methods

of improving the nutrition of pregnant women and infants. One

approach might be to authorize physicians and local public

health agencies to issue to needy pregnant women and to needy

mothers of infants coupons redeemable in grocery stores

for certain foodstuffs needed for adequate nutrition and which

are not likely to be obtained othervise. such coupons would be

redeemable to sore state agency for cash by the grocery stores.

r',0)SkfIl 1,40?

30

3. The present provision for immunization against smallpox,

'polio, measles, mumps, etc. and for chest X-rays be modified

from merely authorizing local public school boards to have such

a requirement to a state-wide requirement for all children

entering any school in the state, public or private.

4. The present law which states that the state board of

education shall make "adequate provision for . .health exam-

ination" of school children be strengthened considerably. In

particular, schools should be required to administerand given

adequate funds to accomplish -- physical examinations of children

at certain intervals, such as a medical examination of each

child upon entry into any public or private school in the state,

and when each child is in the sixth grade and the eleventh

grade; a dental examination of each child upon entry into any

public or private school in the state, and when each child is

in the third grade and the seventh grade; and sight and hearing

tests of each child annually.

5. Legislation be enacted to authorize school districts

to employ physicians, nurses, dentists, dental hygenists, and

other health care personnel on either a part-time or full-time

basis, paying for these persons from any combination of local,

state, and federal funds which may be available. School districts

should also be authorized to provide space and equipment for

health care personnel to conduct physical examinations and provide

limited care and treatment for school-age children who are in

need of such services.

31

6. Legislation be enacted such that recommendations

from a physical examination of a child by school health care

personnel be sent to the parents (or guardians) and where

designated, to the family physician or dentist. In addition,

this legislation should provide that the child's teacher or

teachers be informed of health conditions that may affect the

child's behavior or appearance or learning.

7. Legislation be enacted to appropriate state funds

for and make provision (possibly through the accreditation

procedure) for each school district to have a certain number

of health service personnel, including nurses, dental

hygenists, physicians, and dentists. As a minimum, each

school district should have a nurse, and additional nurses

should be made available for not more than each 1,500

`students or major fraction thereof.

8. Legislation be enacted to provide community health

services for minors similar to the following provisions in

Alabama, i.e.,

Any minor may give effective consent for any legallyauthorized medical, health or mental health servicesto determine the presence of or to treat pregnancy,venereal disease, drug dcPendency, alcohol toxityor any reportable disease and the consent of no otherperson shall be deemed necessary.

In addition it should be added that the giving of the medical,

health or mental health services to the minor will be held in

confidence and, as necessary, free of charge.

32

9. Inasmuch as not all children attend the public

schools, the law providing for the testing for sickle cell

anemia be expanded to provide for testing at times other

than "before or during the first year of attendance in a

public school." One such time might be in the process of

applying for a marriage license.

10. Legislation be enacted to require thorough physical

examinations of prospective participants in all sports with

the danger of physical injury and the attendance of a physician

at each interscholastic athletic event of a contact nature.

11. By legislation or accreditation requirement,

each school building have at least one adult assigned to it

who has successfully completed an approved first-aid course.

'12. Certification requirements include the mastery of

rudiments of first aid, such as the initial treatment of minor

cuts and burns, fainting, etc.; the ability to recognize

symptoms of diabetes, eye problems, hearing problems,

epilepsy asthma, etc.; aiding a person with an epileptic

seizure, etc.

NOTES

(1) Hartman v May et al. 168 Miss. 477, 151So. 737 (193/1).

(2) Ibid.

(3) Triplett v Cobb 331 F. Supp. 652. (N.D.Miss. 1971).

(4) Peo le v Board of Education, 234 Ill 422, 84NE 1046; Mat ews v alamazoo Bd. of Educ. 127 Mich 530,86 NW 1036.

(5) State v Zimmerman, 56 Minn 531, 90 NW 783;Hartman v May, itg-Miss 477, 151 So 737; State v Cole,220 Mo 697, 119 NW 424.

(6) Streich v Board of Education, 314 S.D. 169,147 N.W. 779.

(7) Hallett v Post Printing & Pub. Co. 68Colo 573, 192 P

(8) McOilvra v Seattle School District. 1133Wash 619, 194 P 817.

(9) Zucht v King, 260 U.S. 174; Cude v State,237 Ark. 927, 377 S.W. 2d 816; Hartman v May., 168 Miss1177, 151 So. 737.

(10) Ibid. See alpo State v Board of Education,76 Ohio 297, 81 N.E. 568.

(11) In addition to Zucht and Cude (supra), seealso Hutchins v Durham, 1377176: 68, 4-0-7.E. 46.